1962464404 NPI number — SHORE MEDICAL ASSOCIATES PA

Table of content: (NPI 1962464404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962464404 NPI number — SHORE MEDICAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORE MEDICAL ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962464404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 289
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08754-0289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-240-4545
Provider Business Mailing Address Fax Number:
732-505-3257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 RT 37 W
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-240-4545
Provider Business Practice Location Address Fax Number:
732-505-3257
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONDIT
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
732-349-0011

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C19107 . This is a "RR MCR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com